NCQA PCMH 2014 Linda J. Pepper, Ph.D., PCMH CCE Executive Director Transformational Healthcare Decisions about Recognition and Renewal June 18, 2014.

NCQA PCMH 2014

Linda J. Pepper, Ph.D., PCMH CCE

Executive Director

Transformational Healthcare

Decisions about Recognition and Renewal

June 18, 2014

Discussion

• Timeframe for Transitions• Comparison of PCMH 2011 to PCMH 2014• What’s Best for Your Practice?• Differences in PCMH 2014• What are your PCMH Options?• Decisions and Considerations• How Visualutions Can Help• Recommendations• Q&A

2011 & 2014 Timelines

3/24/2014• NCQA PCMH 2014 Standards

released

6/30/2014• Last day to purchase

2011 ISS tool and online application

12/31/2014 • Last Day to submit PCMH 2011 ISS tool

3/31/2015• Last day to

submit PCMH 2011

Only 10 months left!

NCQA is Raising the Bar!

• 2011 PCMH Standards MU Stage 1 28 Elements 152 Factors (2 not

scored)

• 2014 PCMH Standards MU 2 27 Elements 178 Factors (10 Not

Scored) Increased emphasis on:

Team Care Mental/behavioral health Processes Analytics Quality Improvement High-Need Populations Transformation

More Documentation

Increased Emphasis on Team-Based Care

Care Management Focuses on High-Need Populations

Enhanced Alignment with Triple Aim

Increased Emphasis on Behavioral Health

Enhanced Focus on Sustained Transformation

PCMH 2014 Change Summary

• New Factors– 37 new requirements – 6 new MU2 measures– Higher thresholds on most MU factors

• Increased emphasis in several areas• Technology

– For 30% of factors you MUST have an eHR!– An additional 20% of factors are extremely

difficult without an “advanced” EHR (registry)

What is an “Advanced EHR?”

2014 Edition – Complete product with CQM Flexible, customizable “registry” with ability to run complex

clinical and demographic queries

For Example: Obtain list of patients that…• Are over 65• Are dual eligible (Medicare/Medicaid)• Have 10 or more active meds• Have a Dx of Depression

– And CHF and COPD– Or DM with A1c > 9

• Have been discharged from hospital 2 times or more in last year– Or have been to the ED 2 times or more in last year– Or have 6 or more specialty referrals in last year

PCMH 2014 (6 Standards/27 Elements/100 Points)

Deeper Dive Into PCMH 2014

• PCMH 2011 Must Pass Access during office hours

Same Day Appointments Clinical advice by phone

Outreach Care Management Self-Mgt Care Support Referral Tracking Quality Improvement

• PCMH 2014 Must Pass Access during and after hours

Same Day Appointments Access analysis

Advanced Team Care Outreach Case/Care Management Referral Management Quality Improvement

Access to Care

The Care Team

OutreachNotables: No big change in

MUST PASS One extra

mental/behavioral health

Overuse/appropriate use

A few new items you may not be recording: Occupations Contact info for

specialists Health literacy level

Care Management

Care Coordination

Quality Improvement

Decisions, Decisions?Small

Sin gle Site

M u lti -Site

FQHC

Sin gle Site

M u lti -Site

Your PracticePaperEHR

No MUMU 1

Advanced EHRMU 1MU 2

Your Practice

2011 PCMH

2008 PCMH

Exp.< 3/31/2015

Exp. < 3/31/2015

No PCMH

Got ISS

Started

Not Started

Nothing

Your Practice

Have Support

Grant

Payer

Startup + PMPM

Startup only

PMPM Only

PMPM+Shared Savings

All Types

Unknown

State

Private Payers

No Support

Verified

Type

Tech

Status

Funds

The Easy Decisions

• Your practice already has PCMH 2011 recognition – you do nothing until renewal.

• You decide not to pursue PCMH recognition.

• Your practice is working on your PCMH 2011 application – no time to lose!

• You are submitting a multi-site 2011 – your corporate tool must be in by December 31, 2014 and all sites completed by March 31, 2015.

Do you go for 2011 or do 2014?

If you are… In a Medium to Large Practice With standardized & documented processes An emphasis on integrated behavioral health With an advanced HER and state of the art Registry Able and willing to do Meaningful Use Stage 2

2011 2014Less work in less time…

More work in with more time…

When is 2014 the only choice?

If you are…A health system with a large number of

physicians and dozens of sites under one Corporate application.

and/or you are…Starting now with little to no prior

experience or knowledge of PCMH.

Everyone else should be going for 2011!

• PCMH 2011 Advantages for Small Practices With smart work & ingenuity, practices on paper can obtain Level I

recognition Level III recognition is straightforward even for small practices with

MU 1 (or equivalent) Contrary to mythology, lean small practices can become 2011

PCMH recognized The increased 2014 emphasis on Team Care, Mental/behavioral

health, Processes and Analytics is particularly challenging for small practices

Scenarios

What if I try but can’t finish in time…?

What can Visualutions do to help?

• Use these slides to see if the new or expanded factors present a challenge for your practice.

• If you go for 2011 or 2014, sign up for our Visualutions PCMH reports and dashboard with a consulting package.

• Either way, Visualutions has the reports, training, consulting and technology that can help you reach Level III recognition.

Visualutions’ PCMH Program

PCMH Reports Module & Dashboard

PCMH Manual

Coaching Pre-Assessment

PCMH Library of Materials

Workflow Assessments

On-going Monitoring

A Quick Look at Some of Our Materials

Recommendations

• Make an informed PCMH decision…even if it is to do nothing!• Find out if there are any incentives – current or planned.• Learn and better understand what PCMH means and the

effort involved– Ignore the myths– Your medical home is yours to build

• With a few exceptions, go for 2011 recognition– Your current preparedness and EHR capabilities– Raising the bar on your future

• Let us help you– Talk to us– Take a look at our reports, services and tools– Let us do a quick assessment to help you plan

Some Resources

Visualutions Resources

• Your sales executive! Contact them at [email protected]

• Schedule a demo with your sales executive to see how our system works.

• Linda J. Pepper, PhD, PCMH CCE at [email protected]

Presentation Resources

• Margalit Gu-Arie, M.Sc., NCQA PCMH CCE, Founding Partner for BizMed Solutions

• NCQA PCMH 2014 Guidelines, www.ncqa.org

/visualutions /visualutionsCHC /visualutionsCPS

Questions?